3. Insulin, GLP-1, Ageing Flashcards
What non-therapeutic options can be provided for Diabetes?
- Education/Information for self-management
- Focus on Diet/Lifestyle change
- Psycho/Social Support
- Controlling CV risk factors
- Regular Screening
How often are Diabetic patients seen per year?
Twice
What is discussed in Annual Reviews for Diabetic patients?
- Review Symptoms
- Review Clinical issues
- Glucose
- BP
- Cholesterol
- Albumin Creatinine Ratio - Screen complications
What things can be targeted/changed when treating patients?
- Smoking
- BP
- Cholesterol
- Screening
- Glucose Control
How can we encourage diabetic patients to stop smoking?
1 cigarette in a Diabetic = 5 for Non-Diabetics
How can we adjust BP in diabetic patients?
FIrst Line: ACEI, CCB
- Aim for 140/80
- Aim for 130/80 if CVD or Renal disease
How can we adjust Cholesterol in diabetic patients?
Give a statin if:
- Diabetic > 40
- Diabetic < 40 BUT 1 RF
Aim for <4 mmol/L
OR LDL < 2 mmol/L
How can we Screen for diabetes?
Eyes: Digital Retinal Photography Yearly
Feet: Yearly check for Pulses and Nerves
Kidneys: Yearly ACR and eGFR (Serum creatinine)
What are the best ways to assess Glycemic Control?
- HbA1c: High glucose = more Hb glycation
- Past 3 months due to RBC life - Self Monitoring BG (SMBG)
- Patients test using ia meter
- For patients on insulin therapy
- Pre-prandial: 4-7
- Post-prandial: 5-9 - Fructosamine
- 2 weeks
- Used if HbA1c is shit due to Haemoglobinopathy
- Also for Pregnancy use
What are the main dietary ways of treatment?
- Low in Fat/Sugar/Salt
- High in Fibre/Fruit/Veg
- 30 minutes of exercise 3x a week
- 3-5% weight reduction
- Early usage of Oral Hypo Agents
What are the main Medications for Hyperglycemia?
- Biguanides
- Sulfonylureas/ Prandial Glucose Regulators
- Alpha Glucosidase Inhibitors
- TZDs
- DPP-4 Inhibitors
- GLP-1 Analogues
- Insulin
What do Sulfonylureas and PGRs do?
Increase Insulin Secretion from Pancreatic Beta cells
What do Biguanides do?
Improve insulin sensitivity in the Liver and Muscle
Liver: Less Hepatic Glucose Output
Muscles/Adipose: More glucose used
What do Alpha Glucosidase inhibitors do?
They reduce intestinal glucose absorption
What do TZDs do?
They improve insulin sensitivity
Liver: Lowers Insulin resistance and Hepatic glucose production
Muscle: Lowers insulin resistance and increases glucose uptake
Pancreas: Increases Insulin secretion
What is GLP-1
31 AA Peptide (INCRETIN)
- Secreted after a meal
- Stimulates Insulin secretion
- Decreases Glucagon secretion
- Delays gastric emptying
- Induces Satiety
- Increases Beta cell function
Why can the Gila monster go on for 6 months without eating?
Saliva makes Exendin-4 to suppress appetite
What is Exenatide?
GLP-1 Analogue and Peptide
- Suppresses Appetite
- Stimulates Insulin release
When can you given Exenatide?
BMI above 35 and poor glucose control
Give two examples of GLP-1 Analogues
Exenatide
Liraglutide
Lixisenatide
What are DPP-IV Inhibitors also known as
Gliptins
How do DPP-IV inhibitors work?
Inhibit GLP-1 Breakdown
Increases Endogenous GLP-1
What is the profile of Gliptins?
Oral
Once Daily
Well Tolerated
3rd Line Therapy
What is the order of Diabetic Medication Line Therapies?
- Metformin
- Sulfonylurea
- Glitazone/Gliptin/Insulin
- Insulin + Met + Sulfo
- Intensify insulin or + Glitazone
